Provider Demographics
NPI:1477826139
Name:NELSON, JODI LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HILO DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1079
Mailing Address - Country:US
Mailing Address - Phone:541-912-1220
Mailing Address - Fax:
Practice Address - Street 1:4780 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-1755
Practice Address - Country:US
Practice Address - Phone:541-463-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8423OtherSTATE PHAMACIST LICENSE